- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $588,843.66
| Facility | | $588,843.66 | $588,843.66 | $588,843.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $707,945.78
| Professional | | $588,843.66 | $588,843.66 | $707,945.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61,659.50 / $74,131.02 / $100,000.00
| Facility | | $61,659.50 | $74,131.02 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $588,843.66
| Facility | | $588,843.66 | $588,843.66 | $588,843.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549,540.87 / $549,540.87 / $588,843.66
| Facility | | $549,540.87 | $549,540.87 | $588,843.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $616,595.00
| Professional | | $588,843.66 | $588,843.66 | $616,595.00 |